Sequential cranial MR findings of asymptomatic and neurologically symptomatic HIV⁺ subjects

To compare results of a prospective MR and clinical reevaluation of HIV⁺ asymptomatic and neurologically sympatomatic subjects who had had initially abnormal cranial studies to determine what cranial MR changes occur and how these changes correlate with serial neurologic and neuropsychologic findings. Patients and Methods: Thirty-one asymptomatic (n = 20) and neurologically symptomatic (n = 11) subjects seropositive for the human immunodeficiency virus (HIV⁺) were prospectively reevaluated by cranial magnetic resonance (MR) one to two years following an initially abnormal MR of the brain. Results: All 31 HIV⁺ subjects with initial abnormal MR had abnormal follow-up scans (showing atrophy and/or white matter lesions). Twenty-seven showed no progression of MR abnormalities (among whom were 18 with minimally abnormal scans who remained asymptomatic with improved or static neuropsychologic performance). Of the four subjects with scan changes (all with clinically suspected HIV encephalopathy), one showed MR, clinical, and neuropsychologic test improvement; the remaining three showed MR (n = 3), neurologic (n = 3), neuropsychologic (n = 1) worsening and autopsy (n = 1) confirmed the presence of HIV-1 containing multinucleated giant cells in the brain. Conclusions: This study suggests that: 1) Progression of intracranial MR abnormalities due to HIV-1 is seen only in a minority of HIV⁺ subjects over a 1- to 2-year time period, only in those neurologically symptomatic, and correlates with clinical deterioriation. 2) Minor cerebral MR abnormalities seen in HIV⁺ subjects who remain neurologically asymptomatic do not change over a 1- to 2-year period. 3) Although HIV is known to infect the brain early, it may, nevertheless, not routinely do significant anatomical damage early on in the disease, as based on MR criteria.